Obamacare data point

[marplots]

This bit about not wanting insurance coverage sounds Ok at first. But if you rack up huge medical bills and go bankrupt, suddenly things aren't so good. The hospital still has to pay the doctors and suppliers for the care they gave you. Which means, in the end, I have to help pay.

One solution would be to deny you care or make you pre-pay for it. But then I feel bad when people are left to die from treatable maladies. "Sorry Mr. Jones, that toe nail is just going to have to remain infected for now..."

I think I'd rather feel bad for forcing you to get insurance than feel bad by either paying for your care myself or denying you care altogether.

It's not that those other methods don't work, we have the first now, we used to have the second, and the third is popular in third world countries.

 

[TragicMonkey]

Lifetime caps and preexisting conditions. In the bad old days insurers could let you die, after collecting your money, because you became unprofitable. Anyone want to return to that?

 

[ponderingturtle]

Lifetime caps and preexisting conditions. In the bad old days insurers could let you die, after collecting your money, because you became unprofitable. Anyone want to return to that?

It is the number one goal of the republican party. OTherwise they would be offering up a new plan instead of just "Repeal Obamacare"

 

[jimbob]

The only solution is to make the most cost effective system of all available to all; namely Medicare (which is not to say that this doesn't need improvements and reduced shackles).

Anyone who thinks that "competition" exists in health care is an idiot who has never asked for rates while in an ambulance, or checked every specialist in a hospital to verify their participation in your health plan before they open their mouth and bill for consultation.

We have the stupidest most corrupt health care system on the planet.

It's an old post of Cain's but one of his best I think on this subject:

If we had an actual free market, then most of these problems would disappear. First of all, in a free market there are no barriers to entry, and this assumption holds up particularly well in the case of health-care where anyone can start a local business. All of this competition means lower prices for you (and lower profits for business). Second, consumers are informed (no asymmetries); they're not swayed by silly superstitions and they don't need something like ten years of training. Moreover, bad decisions are perfectly reversible and consumers have lots of time to shop around. Third, indivisible benefits and costs: not happenin' here. When other people get sick and die, it's on them. Some people -- yes, I'm talking about communists -- like those two old white guys in the video -- will complain about how much is lost in "worker productivity" on account of days missed due to tooth aches and chest pains. Well, boohoo. Fourth: the children. It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive to you. If it does sound counter-intuitive, then you're stupid, and you need to get your "duh-face" checked out... if you can. Fif: no government bureaucrats. Instead of decisions made by some poindexter in Washington who thinks he knows more than your doctor, under a free market they'll be made by some business major in Connecticut who doesn't care if he knows better than your doctor.

See my sig for the relative costs of the US and UK systems.

 

[paulhutch]

Medicare actually costs, for the cheapest person, 850$ a month, not including deductibles and copays. That is literally the payment CMS makes to managed care groups. Allowing someone to buy in, in the most literal meaning, would be allowing someone to make that 850 a month payment (possibly more) to access the care.

I might not have the right number on what the final payment is. Im looking.

I think you do have the amount correct. If you look at the per beneficiary spending here (about half way down the page): http://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/

Then take into account that Parts B & C are only about 73% paid for by the government you get about $850/month per beneficiary. Which isn't too bad considering that Medicare beneficiaries are primarily elderly or disabled, the highest cost type of people. My employer pays about $500/month for an individual policy and our group is all non-disabled and almost all non-elderly people (only 1 out of the 100 covered is over 60).

 

[LTC8K6]

The goal of PPACA is single payer national health care.

That's the only thing that makes sense, given PPACA's poorly thought out planning and execution.

The idea that you could cover lots more people, and offer each person more coverage, and most are going to pay less, never seemed workable to me.

 

[Kestrel]

It is the number one goal of the republican party. OTherwise they would be offering up a new plan instead of just "Repeal Obamacare"

The new plan is called "Patient Centered Health Care". The marketing team found some good words but there are only a few details on how it works.

Health Savings Accounts will be expanded. A system that benefits families in high tax brackets far more than working class Americans.

They also want to open up the market so people can buy insurance across state lines. The insurance companies will be able to follow the example set by credit card companies. Moving operations to the state with laws least favorable to consumers. Laws passed by legislators you can't vote out of office.

 

[Kestrel]

Lifetime caps and preexisting conditions. In the bad old days insurers could let you die, after collecting your money, because you became unprofitable. Anyone want to return to that?

In the good old days before the horror of Obamacare you could buy health insurance for as little as $75 a month with no deductible and a $20 copays to visit the doctor. The only catch is that the insurance only covered six routine doctors visits a year.

The doctor got $120 for each visit, $20 from you and $100 from the insurance company. If you went six times during the year the insurance company had to pay out a maximum of $600. Your premiums for that same year would total $900.

 

[xjx388]

The "get creative" part has a hidden flaw. It's revealed in one of the parts you'd like to keep: the "pre-existing condition" clause. By limiting coverage for someone with a preexisting condition, I am able to offer coverage to other customers cheaper - people's prior medical history predicts how much future care they will need. Expensive care.

I can also get creative with zip codes, gender, race, age and a bunch of other things. In fact, I can get so creative I can exclude all the really high risk people and market to only low risk folks. This was considered a systemic problem in how we used to do insurance.

In a really simplified form, think of it this way: Keep everything in ACA except for the part that defines a Qualified Health Plan. Maybe I want my catastrophic plan back where I'm covered only after my expenses reach, say, $20k. Maybe you need a similar plan with a lower deductible. Maybe Bob over there needs a plan akin to a Bronze plan now. I'd just like to see more kinds of plans qualify to avoid the tax penalty.

One other try was to fund a kind a catastrophic fallback so those at the fringe - the possibly millions of dollars in care - could be funded either by the government directly or by pooling some fee to all the insurance carriers. This has been done with variable success. In Michigan, we did it for motor vehicle accidents where the injured couldn't get payment (for whatever reason). It kicks in when medical bills exceed $500,000. They fund it with fees on automobile registrations and drivers licenses.

I checked, and as of 2015, the fund had upwards of $20 billion in it. Apparently it's over-funded and lawmakers are keen to get at the extra money to use it for other projects. So we overpaid.

I wouldn't mind a national catastrophic insurance plan. That's basically the Singapore plan that I'm so fond of. Let's say we all pay into a plan that covers all citizens after $50k (just a number) in expenses/year. Now the insurance companies can get creative in crafting plans to cover those who need coverage before the $50k kicks in. In my case, I might get a plan that covers me only after I spend $20k. Since we are made more responsible for covering our own routine care, this would cause doctors, hospitals, pharma, etc to compete on price, quality, etc.

There are lots of ways to fix the problem. Yes, Canada/UK-style UHC is one of them. But it's not the only and there may be better solutions if we take a serious stab at the problem outside of politics.

 

[twinstead]

There are lots of ways to fix the problem. Yes, Canada/UK-style UHC is one of them. But it's not the only and there may be better solutions if we take a serious stab at the problem outside of politics.

Now that's just crazy talk!

 

[marplots]

There are lots of ways to fix the problem. Yes, Canada/UK-style UHC is one of them. But it's not the only and there may be better solutions if we take a serious stab at the problem outside of politics.

I agree, except the answer we get is going to depend on what we think the problem is and what we decide is an acceptable solution. For example, training doctors on the government dime and paying them much, much less. Denying certain types of lawsuits for medical malpractice. Limiting services for those who cost the most...